For many people, stress is accepted as a typical experience of modern day living. Depression, which effects one in five people in a lifetime, is also considered a common illness and can occur in any person irrespective of gender, age, socioeconomic status or any other lifestyle variable.
We are now coming to understand more fully, through the advances in integrative medicine and comprehensive research into mind-body medicine, that what we think effects how we feel, and what we feel effects how with think. In other words, the mind influences the body and the body influences the mind.
Integrative medicine provides us with a range of effective treatment options for depression and stress relief that extend beyond prescription medication to ‘whole of life, whole person’ lifestyle interventions. Treating depression and managing stress is understood to be fundamental to the treatment and prevention of disease in the body, and managing the complex connection between physical and emotional (or mental) health is considered vital to general health and wellbeing. Research indicates that less than 25 percent of people experiencing depression have access to effective treatment. Integrative medicine provides a broad range of treatment responses that can be individually matched to each person, and can embrace a broad range of non-invasive, non-drug treatments that deal with cause and not just effect.
The experience of stress, or how we respond to a ‘life stressor’, is highly individual. What is considered stressful for one person may not be for another. Personality type studies have been the source of much understanding about the inherent coping mechanisms that cluster around different personalities, and contribute also to our understanding of predisposition or susceptibility to illness. For example, a Type 1 personality is often a high achieving, executive type with a highly functioning survival mode. A Type 2 personality is more likely to submit to an unfavourable situation or feel helpless. In this model, a Type 2 personality is more likely to experience stress. (Google ‘Life Event Stress Scale’ for more information on life stressors.) It is important to realise too, that not all stress (or distress) is negative. Positive stress (eustress) is a response that can ensure our survival through quick and appropriate response to danger and also be a motivating force towards adaptation, performance, change or development.
The connection between stress and depression and health is best explained through the disciplines of Psychoneuroimmunology (PNI) and Psychoneuroendocrinology (PNE). Stress and depression influence the body through the brain – PNI is the study of how the mind influences the immune system (to be normal, abnormal or hyperactive) and PNE describes how the mind influences the body’s hormones.
Stress and depression both influence hormonal levels, increasing cortisol, growth hormone, prolactin, insulin and adrenaline. Cortisol and growth hormone increase insulin resistance, and adrenaline stimulates the breakdown of glycogen into glucose. Insulin resistance has long been associated with the onset of diabetic conditions, but more and more researchers are coming to understand how increasing insulin levels in the body, and compromised immunity, is associated not only with diseases such as cardiovascular disease, diabetes and cancer, but also every disease that manifests in the body.
Another way of considering the function of the brain or mind is in its capacity of ‘storage’. It is not what ultimately happens to us that affects our health, but how we store it in the brain. For this reason, integrative treatments that support the unloading or processing of material psychologically, and attend to brain chemistry directly (through supplements and nutrition) can be highly effective. For Type 2 personalities this may even be essential.
Within the field of mind-body medicine research, many treatment options have been identified through evidence-based research as equally effective, if not more effective, than anti-depressants for mild to moderate depression. For example:
Therapy and Counselling – Cognitive behavioural therapy (CBT), group therapy, support groups and counselling provide valid outlets for the expression of emotions and discussion around stressful life events. Writing therapy, music therapy and developing community and family support networks and social connections can all be beneficial.
Meditation and relaxation – Finding effective tools to manage stress and anxiety can improve coping mechanisms and foster better breathing in the body. Meditation and stress management sessions can provide valuable insights for personal practice. Meditating is cost-free and available anywhere, anytime.
Nutrition and diet – A poor diet has been proven to be associated with the development of depressive symptoms. A healthy balanced diet rich in fruits, vegetables and deep sea fish (for essential fatty acids) is advisable. Some studies indicate lactose malabsorption is linked to depression, so this may also be a consideration. Dark chocolate has many positive health effects and can be mood enhancing in all people, not just those with depression!
Herbal Medicines – Research consistently shows that St John’s Wort can improve mood, reduce anxiety and somatic symptoms and assist in sleep disorders in mild to moderate depression. It is considered a suitable alternative to anti-depressant medication with comparable results in a two to three week period. Research has also shown the herbs gingko biloba, saffron and Rhodiola rosea warrant further research as viable alternatives.
Supplements – Tryptophan (5-HTP) is an amino acid found in many protein foods. It plays a major role in the production of the hormone serotonin and can be used as a supplement if dietary sources are inadequate. SAMe – used regularly in Europe to treat depression, works with 5HTP to affect melatonin, dopamine and serotonin production. A deficiency in Omega 3 fatty acids has been linked to depression and studies show promising results with Omega 3 supplementation.
Vitamins and Minerals – Vitamins such as folate, the B group and a quality multivitamin may be useful. These support brain function and are cofactors in the production of serotonin. Similarly deficiencies in the minerals magnesium, calcium, iron and zinc can be related to a variety of psychological symptoms and brain functioning.
Herbal medicines, supplements, vitamin and mineral therapy protocols should be developed by an experienced practitioner as some contraindications exist and may not combine effectively with some conventional medicines.
Sunshine – A deficiency in Vitamin D is a known precursor to depression. Seasonal Affect Disorder (SAD) is often experienced during winter months and prudent sun exposure and Vitamin D supplementation can assist greatly. Some people may need additional Vitamin D throughout the year. Light therapy, where patients are exposed to a bank of lights for several hours each day
can also help.
Physical Activity – According to research, regular exercise can improve mood and reduce symptoms of stress and depression as effectively as an anti-depressant. Exercise releases endorphins in the body and reduces cortisol. It can provide opportunities for social interaction and is highly accessible. An exercise prescription may be of more value in depression than a medicine prescription. Other physical therapies such as massage, tai chi and yoga can be beneficial and help us to manage our ‘storage’.
Adequate Sleep – Sleep deprivation and chronic insomnia are both contributors and responses to stress and depression. Adequate sleep is important for hormonal regulation and mood, and quality sleep, with normal sleep patterns can have a significant impact on depression. Rest well to be well.
Substance Abuse – Limiting or avoiding smoking, recreational drugs and alcohol, and some prescription medicines (including the contraceptive pill) is recommended. Substance abuse and depression are highly associated and are risk factors for suicidal behaviours and social and personal impairment, as well as other psychiatric conditions. Alcohol abuse increases the risk of major depression by 65 percent.
Meaning and Purpose – Finding meaning and purpose in life is an important part of being human and alive. For some, this is found through religious or spiritual endeavours; however, developing a deeper connection with the self and with nature is another expression of purposeful living.
Research shows that only one in five people showing the signs of depression or mental distress actually seek medical support. Stress and depression can be managed and Integrative Medicine provides many options that improve this condition, overall lifestyle and long term health. Please visit an Integrative GP, a health professional or mental health service, if you or someone you love is experiencing unmanageable levels of stress or depression. Serious mental illness requires treatment.
Calmness and tranquility may just be the best medicine for mental or emotional health, and can be cultivated in each of us as a response to the stresses of contemporary life. In an integrative approach, caring for the mind is just as vital for health and wellbeing as caring for the body.
Professor Avni Sali is Founding Director of the National Institute of Integrative Medicine (NIIM).